During the initial five year period of the ICER (between 2003-2008), apart from renovating and equipping a 4000sq ft laboratory building, a modern IT backbone was established that enabled a secure computer network with both high speed connections to the NIHs online resources and software for clinical and basic laboratory research. Videoconferencing was put into place that not only enabled sharing of research presentations and regular dialogue among the scientific staff in India and at the NIH, but also has been used for interactive training. Furthermore, redundant systems (from air handling to backup generators) and preventative maintenance for equipment and the infrastructure built is part of the overarching ICER approach. Moreover, a senior NIH/NIAID Staff Scientist,was detailed to the site to oversee the laboratory operations related to the ICER program and to act an on-the-ground liaison between the NIAID and the TRC.[unreadable] [unreadable] Because training was always an integral part of the ICER concept, there were a large number of on-the-ground training forums as well as short term training opportunities for collaborating members of the TRC staff. In Chennai, training sessions were based on the perceived needs of the TRC staff and included courses in GCP and GLP, biostatistics, biosafety, good accounting practices, clinical trials design, antiretroviral therapy, and HIV care among others. Three to six month laboratory based collaborative research was undertaken by a number of staff and students at the TRC that included work on multicolor flow cytometry in HIV, pharmacokinetics, human genetics of extrapulmonary tuberculosis, proteomics of mycobacteria, pulmonary immunology, advanced clinical microbiology in HIV, and mycobacterial genetics. Shorter term training was made available to several members of the clinical research staff in the United States, South Africa and in Uganda. [unreadable] [unreadable] Because the main focus of the ICER program is on research, both basic and clinically-relevant, a great effort was placed on both establishing clinical research protocols and making inroads into the understanding of the pathogenesis of lymphatic filariasis, HIV, and tuberculosis. In the past year, a clinical trial of the influence of helminth infection on mycobacterial infection was completed, and enrollment was begin in an HIV/filarial co-infection trial. Two clinical trials are underway (both in Chennai and Alleppey) examining effects of new regimens for lymphatic filariasis. A set of 110 single nucleotide polymorphisms (SNPS) have been assessed for understanding both susceptibility to extrapulmonary tuberculosis and to various disease outcomes in lymphatic filariasis. Studies of local immune responses (pulmonary) in tuberculous pleuritis, studies of innate and adaptive immune responses in lymphatic filariasis, and studies demonstrating an integral role of PD-1 and IL-10 in modulating the immune responses in latent tuberculosis have all been completed.